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Article ; Online: Low anterior resection syndrome - 'braking' our focus with the pelvis.

Burke, John P

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2021 Volume 23, Issue 2, Page(s) 339–340

MeSH term(s)	Abdomen ; Humans ; Pelvis/surgery ; Postoperative Complications ; Rectal Neoplasms ; Syndrome
Language	English
Publishing date	2021-03-17
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.15548
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Article ; Online: Transanal ileal pouch-anal anastomosis: A systematic review and meta-analysis of technical approaches and clinical outcomes.

Stephens, Ian J B / Byrnes, Kevin G / Burke, John P

Langenbeck's archives of surgery

2024 Volume 409, Issue 1, Page(s) 153

Abstract: Purpose: Transanal minimally invasive surgery has theoretical advantages for ileal pouch-anal anastomosis surgery. We performed a systematic review assessing technical approaches to transanal IPAA (Ta-IPAA) and meta-analysis comparing outcomes to ... ...

Abstract	Purpose: Transanal minimally invasive surgery has theoretical advantages for ileal pouch-anal anastomosis surgery. We performed a systematic review assessing technical approaches to transanal IPAA (Ta-IPAA) and meta-analysis comparing outcomes to transabdominal (abd-IPAA) approaches. Methods: Three databases were searched for articles investigating Ta-IPAA outcomes. Primary outcome was anastomotic leak rate. Secondary outcomes included conversion rate, post operative morbidity, and length of stay (LoS). Staging, plane of dissection, anastomosis, extraction site, operative time, and functional outcomes were also assessed. Results: Searches identified 13 studies with 404 unique Ta-IPAA and 563 abd-IPAA patients. Anastomotic leak rates were 6.3% and 8.4% (RD 0, 95% CI -0.066 to 0.065, p = 0.989) and conversion rates 2.5% and 12.5% (RD -0.106, 95% CI -0.155 to -0.057, p = 0.104) for Ta-IPAA and abd-IPAA. Average LoS was one day shorter (MD -1, 95% CI -1.876 to 0.302, p = 0.007). A three-stage approach was most common (47.6%), operative time was 261(± 60) mins, and total mesorectal excision and close rectal dissection were equally used (49.5% vs 50.5%). Functional outcomes were similar. Lack of randomised control trials, case-matched series, and significant study heterogeneity limited analysis, resulting in low to very low certainty of evidence. Conclusions: Analysis demonstrated the feasibility and safety of Ta-IPAA with reduced LoS, trend towards less conversions, and comparable anastomotic leak rates and post operative morbidity. Though results are encouraging, they need to be interpreted with heterogeneity and selection bias in mind. Robust randomised clinical trials are warranted to adequately compare ta-IPAA to transabdominal approaches.
MeSH term(s)	Humans ; Proctocolectomy, Restorative/methods ; Proctocolectomy, Restorative/adverse effects ; Anastomotic Leak/etiology ; Transanal Endoscopic Surgery/methods ; Transanal Endoscopic Surgery/adverse effects ; Treatment Outcome ; Length of Stay/statistics & numerical data ; Colonic Pouches/adverse effects ; Operative Time ; Anastomosis, Surgical/methods
Language	English
Publishing date	2024-05-06
Publishing country	Germany
Document type	Journal Article ; Systematic Review ; Meta-Analysis
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-024-03343-7
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Article: Role of Fecal Diversion in Complex Crohn's Disease.

Burke, John P

Clinics in colon and rectal surgery

2019 Volume 32, Issue 4, Page(s) 273–279

Abstract: Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in progressive tissue damage, which can result in strictures, fistulae, and abscesses formation. The triggering mechanism is thought to be in the fecal ... ...

Abstract	Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in progressive tissue damage, which can result in strictures, fistulae, and abscesses formation. The triggering mechanism is thought to be in the fecal stream, and diversion of this fecal stream is sometimes required to control disease when all other avenues of medical and surgical management have been exhausted. Fecal diversion can be temporary or permanent with the indications being defunctioning a high-risk anastomosis, as a result of a surgical complication, for disease control, or due to severe colonic, rectal, or perianal disease. The incidence of ostomy formation in CD has increased epidemiologically over time. The primary indication for ostomy formation is severe perianal fistulizing disease. However, while 64% of patients have an early clinical response after diversion for refractory perianal CD, restoration of bowel continuity is attempted in only 35% of patients, and is successful in only 17%. The current review discusses the indications for ostomy creation in complex CD, strategies for procedure selection, and patient outcomes.
Language	English
Publishing date	2019-07-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2048635-2
ISSN	1531-0043
ISSN	1531-0043
DOI	10.1055/s-0039-1683916
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Article ; Online: Meta-analysis of SATB2 immunohistochemical expression in colorectal cancer versus primary ovarian mucinous neoplasms.

Maguire, Barry / Duggan, William P / Prehn, Jochen H M / Burke, John P

Annals of diagnostic pathology

2024 Volume 71, Page(s) 152302

Abstract: Background: Reliably distinguishing primary ovarian mucinous neoplasms (POMNs) from metastatic colorectal cancers (CRCs) is both challenging to the histopathologist and of great clinical importance. Special AT-rich sequence binding protein-2 (SATB2) has ...

Abstract	Background: Reliably distinguishing primary ovarian mucinous neoplasms (POMNs) from metastatic colorectal cancers (CRCs) is both challenging to the histopathologist and of great clinical importance. Special AT-rich sequence binding protein-2 (SATB2) has emerged as a useful diagnostic immunohistochemical marker of colorectal cancer. This meta-analysis compares SATB2 expression in POMNs and CRC. Methods: A systematic literature search for relevant studies was conducted. Meta-analysis of SATB2 positivity was undertaken using a random effects model. Results: Seven studies including 711 CRCs and 528 POMNs were included. SATB2 positivity was seen in 81 % (95 % CI: 72-88 %) of CRCs and 4 % (95 % CI: 1-11 %) of POMNs. Variation was seen in immunohistochemical methods used for SATB2 detection and threshold for positivity. Conclusion: SATB2 staining remains high in CRC and low in POMNs, supporting its use in differentiating these two pathologies with vastly differing prognosis and treatment.
Language	English
Publishing date	2024-04-16
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1440011-x
ISSN	1532-8198 ; 1092-9134
ISSN (online)	1532-8198
ISSN	1092-9134
DOI	10.1016/j.anndiagpath.2024.152302
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Article ; Online: Data, data everywhere, and not a spot to think.

Burke, John P

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2018 Volume 20, Issue 11, Page(s) 953–954

MeSH term(s)	Big Data ; Biomedical Research ; Colorectal Surgery ; Humans
Language	English
Publishing date	2018-11-02
Publishing country	England
Document type	Editorial
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.14440
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Article: How Successful is Combined Superior and Inferior Oblique Muscle Surgery in Young Children with Superior Oblique Underaction Presenting in Infancy with a Severe Head Tilt?

Littlewood, Revelle A / Burke, John P

The British and Irish orthoptic journal

2021 Volume 17, Issue 1, Page(s) 33–40

Abstract: Background/objective: To evaluate the success of combining ipsilateral inferior and superior oblique muscle surgery in young children with congenital unilateral superior oblique under action who present in infancy with a large socially noticeable head- ... ...

Abstract	Background/objective: To evaluate the success of combining ipsilateral inferior and superior oblique muscle surgery in young children with congenital unilateral superior oblique under action who present in infancy with a large socially noticeable head-tilt. Methods: A consecutive retrospective case series of young children was analysed. The success of surgery in eliminating the head-tilt was evaluated by pre- and post-operative ocular motility assessment focusing on the vertical misalignment in primary position and downgaze, the magnitude of the head-tilt in degrees and the status of the superior oblique tendon. Results: Five children had a mean age at first surgery of 41 (range 25-63) months, a mean primary position vertical deviation of 26 (25-30) prism dioptres, a head-tilt of 30 (20-35) degrees and a mean post-operative follow up of 24 (8-43) months. While there was a uniform surgical plan, nonetheless each operation required individualisation based on a spectrum of per-operative superior oblique tendon findings. The head tilt was eliminated in 40% and reduced in the remainder, to a mean of 7 (0-18) degrees and with a mean post-operative primary position vertical misalignment of 3 (range 0-10) and of 10 (range 0-40) prism dioptres in downgaze. Conclusion: Combined, ipsilateral oblique muscle surgery reduced the severe head tilt and primary position alignment to a psychosocially and functionally acceptable level. For the majority, the outcome was stable or associated with further decremental improvement. A persistent downgaze vertical tropia occurred in children with macroscopically abnormal superior oblique tendons but these cases were not identifiable clinically pre-operatively.
Language	English
Publishing date	2021-02-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2163627-8
ISSN	1743-9868
ISSN	1743-9868
DOI	10.22599/bioj.171
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Article ; Online: Transanal minimally invasive surgery (TAMIS) for local excision of benign and malignant rectal neoplasia: a 7-year experience.

Duggan, William P / Heagney, Niall / Gray, Sean / Hannan, Enda / Burke, John P

Langenbeck's archives of surgery

2024 Volume 409, Issue 1, Page(s) 32

Abstract: Purpose: Transanal minimally invasive surgery (TAMIS) is an advanced transanal platform that can be utilised to perform high-quality local excision (LE) of rectal neoplasia. This study describes clinical and midterm oncological outcomes from a single ... ...

Abstract	Purpose: Transanal minimally invasive surgery (TAMIS) is an advanced transanal platform that can be utilised to perform high-quality local excision (LE) of rectal neoplasia. This study describes clinical and midterm oncological outcomes from a single unit's 7-year experience with TAMIS. Methods: Consecutive patients who underwent TAMIS LE at our institution between January 1st, 2016, and December 31st, 2022, were identified from a prospectively maintained database. Indication for TAMIS LE was benign lesions not amenable to endoscopic excision or histologically favourable early rectal cancers. The primary endpoints were resection quality, disease recurrence and peri-operative outcomes. The Kaplan-Meier survival analyses were used to describe disease-free survival (DFS) for patients with rectal adenocarcinoma that did not receive immediate salvage proctectomy. Results: There were 168 elective TAMIS LE procedures performed for 102 benign and 66 malignant lesions. Overall, a 95.2% negative margin rate was observed, and 96.4% of lesions were submitted without fragmentation. Post-operative morbidity was recorded in 8.3% of patients, with post-operative haemorrhage, being the most common complication encountered. The mean follow-up was 17 months (SD 15). Local recurrence occurred in 1.6%, and distant organ metastasis was noted in 1.6% of patients. Conclusions: For carefully selected patients, TAMIS for local excision of early rectal neoplasia is a valid option with low morbidity that maintains the advantages of organ preservation.
MeSH term(s)	Humans ; Neoplasm Recurrence, Local/surgery ; Rectal Neoplasms/surgery ; Digestive System Surgical Procedures ; Proctectomy ; Databases, Factual
Language	English
Publishing date	2024-01-09
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-023-03217-4
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Article ; Online: The effect of implementing a transanal minimally invasive surgical programme for the local excision of early rectal neoplasia on outcomes in a tertiary referral rectal cancer centre.

Duggan, William P / Lenihan, John / Clancy, Cillian / McNamara, Deborah A / Burke, John P

European journal of gastroenterology & hepatology

2024

Abstract: Transanal minimally invasive surgery (TAMIS) is a surgical alternative to proctectomy in the management of complex rectal polyps and early rectal cancers. In 2016, our institution introduced a TAMIS programme. The purpose of this study was to evaluate ... ...

Abstract	Transanal minimally invasive surgery (TAMIS) is a surgical alternative to proctectomy in the management of complex rectal polyps and early rectal cancers. In 2016, our institution introduced a TAMIS programme. The purpose of this study was to evaluate changes in practice and outcomes in our institution in the 3 years before and after the implementation of TAMIS. We conducted a retrospective analysis of a prospective database of patients who underwent proctectomy or TAMIS for the management of complex rectal polyps or early rectal cancers at our institution between 2013 and 2018. 96 patients were included in this study (41 proctectomy vs 55 TAMIS). A significant reduction was noted in the number of proctectomies performed in the 3 years after the implementation of TAMIS as compared to the 3 years before (13 vs 28) (P < 0.001); 43% of patients (n = 12) who underwent proctectomy in the period prior to implementation of TAMIS were American Society of Anaesthesiologists grade III, as compared to only 15% (n = 2) of patients during the period following TAMIS implementation (P = 0.02). TAMIS was associated with a significant reduction in length of inpatient stay (P < 0.001). Oncological outcomes were comparable between groups (log rank P = 0.83). Our findings support TAMIS as a safe and effective alternative to radical resection. The availability of TAMIS has resulted in a significant reduction in the number of comorbid patients undergoing proctectomy at our institution. Consequently, we have observed a significant reduction in postoperative complications over this time period.
Language	English
Publishing date	2024-04-05
Publishing country	England
Document type	Journal Article
ZDB-ID	1034239-4
ISSN	1473-5687 ; 0954-691X
ISSN (online)	1473-5687
ISSN	0954-691X
DOI	10.1097/MEG.0000000000002773
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Article ; Online: Distilling data from dogma: the management of diverticulitis continues to evolve.

Burke, John P

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2017 Volume 19, Issue 4, Page(s) 317–318

MeSH term(s)	Diverticulitis ; Diverticulitis, Colonic
Language	English
Publishing date	2017
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.13650
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Article: Role of Fecal Diversion in Complex Crohn's Disease

Burke, John P.

Clinics in Colon and Rectal Surgery

(Complex Crohn's Disease: Primum non nocere)

2019 Volume 32, Issue 04, Page(s) 273–279

Series title	Complex Crohn's Disease: Primum non nocere
Abstract	Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in progressive tissue damage, which can result in strictures, fistulae, and abscesses formation. The triggering mechanism is thought to be in the fecal stream, and diversion of this fecal stream is sometimes required to control disease when all other avenues of medical and surgical management have been exhausted. Fecal diversion can be temporary or permanent with the indications being defunctioning a high-risk anastomosis, as a result of a surgical complication, for disease control, or due to severe colonic, rectal, or perianal disease. The incidence of ostomy formation in CD has increased epidemiologically over time. The primary indication for ostomy formation is severe perianal fistulizing disease. However, while 64% of patients have an early clinical response after diversion for refractory perianal CD, restoration of bowel continuity is attempted in only 35% of patients, and is successful in only 17%. The current review discusses the indications for ostomy creation in complex CD, strategies for procedure selection, and patient outcomes.
Keywords	Crohn's disease ; ileostomy ; colostomy ; ostomy ; stoma ; fistula ; abscess ; stricture ; colitis
Language	English
Publishing date	2019-07-01
Publisher	Thieme Medical Publishers
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2048635-2
ISSN	1530-9681 ; 1531-0043
ISSN (online)	1530-9681
ISSN	1531-0043
DOI	10.1055/s-0039-1683916
Database	Thieme publisher's database

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